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    ASCTS Report. ASCTS Report. Document Transcript

    • Australasian Society of Cardiothoracic Surgeons (ASCTS) Victorian Cardiac Surgery Database Project Annual Report 2001-2002 Surgeons Report Prepared by:C.M. Reid, M. Rockell, P Skillington, G. Shardey on behalf of the ASCTS Database Project Steering CommitteeASCTS Surgeon’s Comprehensive report 2001-2002 Page 1 of 8312/6/2010
    • ASCTS Surgeon’s Comprehensive report 2001-2002 Page 2 of 8312/6/2010
    • Foreword 2001 – 2002 First Annual Report For ASCTS Database Mr. Peter Skillington President of Australasian Society of Cardiac and Thoracic SurgeonsIt is very pleasing to oversee the initial report, which covers the first year of data collection,for the ASCTS Database for Adult Cardiac Surgery. This is a comprehensive report forcardiac surgeons, which has been modeled on the Society of Cardiothoracic Surgeons ofGreat Britain and Ireland report. Many of you would have seen the initial public report forthis time period of data collection (1/8/01 – 31/7/02), which was presented to the VictorianGovernment, to cover data collected for the six Victorian Public Hospitals which haveparticipated in the database.You will notice that there are three separate reports enclosed, as well as notes on theprocesses used. The three reports are as follows: (a) Public Report – You have already seen this, it was delivered to the Victorian Department of Health in March, 2003. (b) Comprehensive Surgeon’s Report – Detailed analysis of mortality and morbidity of CABG, valve, and other procedures, as well as analysis of results, depending on various pre-operative demographics and cardiac risk factors. (c) In House Reporting Module – Each of the six Victorian Hospitals has the facility to print out a report of any particular period, according to this module. Thus, Victorian Units can compare their own results according to the module, with the overall results.There is quite a bit of duplication present as a result of there being three reports, althoughit does provide a way for each Unit to quickly compare their own results with the overallcohort.With the demise of the National Heart Foundation and AIHW Yearly Reports, we are proudto be able to present a comprehensive report on data collected, near contemporaneously.This report comes out approximately 15 months after the end of the data collection period.Our forthcoming Contract with the Victorian Government, will allow yearly reports to coverfinancial year periods (1st July – 30th June), and our contract states that these reportsshould be available within six months of the end of each collection period.As yet, the ASCTS Database only operates in Victoria, although as many of you would beaware, much effort is proceeding to extend the database to other States as well as NewZealand. At the present time, the only risk modeling that has been performed is risk-adjusted mortality for isolated CABG, according to Euroscore. We hope to develop ourown risk-adjustment model for isolated CABG, as well as other procedures, andcomplications, in due course.I would like to thank all Members of ASCTS, who have worked to make this possible, bothnationally with the development of the original dataset, definitions, ethical and peer reviewaspects, as well as to the individual Members of the Victorian Steering Committee. Iwould also like to thank the Victorian Department of Health Services for their ongoingsupport and funding of this endeavor, as well as Melbourne Information Management, andthe Baker Heart Research Institute for the work that they have done on our behalf.ASCTS Surgeon’s Comprehensive report 2001-2002 Page 3 of 8312/6/2010
    • ASCTS Surgeon’s Comprehensive report 2001-2002 Page 4 of 8312/6/2010
    • IndexIntroduction to the Annual Report of the ASCTS Database 7Public Report (2001-2002) 11Comprehensive Surgeon’s Report (2001-2002) 31 Valve data 32 Isolated CABG data 46 Other group data 56 Factors contributing to morbidity in the whole population 57In-house reporting module – report for all units combined 63Processes 73 Data Management 74 Peer Review Mechanism 75 Data Collection Form 76 Patient Information Sheet 82 Opt-off procedure 83ASCTS Surgeon’s Comprehensive report 2001-2002 Page 5 of 8312/6/2010
    • ASCTS Surgeon’s Comprehensive report 2001-2002 Page 6 of 8312/6/2010
    • Introduction to the Annual Report of the ASCTS DatabaseDevelopment of the ASCTS DatabaseThe proposal for a National Cardiothoracic Database was initiated by theAustralasian Society of Cardiac and Thoracic Surgeons in 1996.The intent was toestablish a system which would: 1. Assess the nature and outcomes of Cardiac surgery in Australasia. 2. Provide Government and other interested Agencies with accurate, validated, contemporaneous, risk-stratified information on surgical outcomes. 3. Allow patients access to information which will enhance informed consent. 4. Ensure the highest continuing standards of Cardiac surgery in Australasia.This naturally demanded the following essentials: 1. A minimum Dataset. 2. Establishment of specific Definitions for the Dataset. 3. Inclusion of all patients in the Database. 4. Validation of all data. 5. Risk adjustment, or Stratification, of outcome data. 6. Contemporaneous availability of information.Australian Cardiac surgery has a long history of data accumulation, initially throughthe NHF and subsequently the AIHW. However, this information was limited tonumbers of procedures and mortality. It did not and could not comply with therequirements of the ASCTS.Therefore a meeting to establish a Cardiac Surgical Database was held at EpworthHospital in late 1997. The Victorian Government then established a consultativereview to assess existing Cardiac Surgery Unit data collection systems and thefeasibility of constructing a common database. This review recommended that theASCTS initiative proceed.Importantly, the Victorian DHS provided financial support for the Database projectto proceed in Victoria, on condition that its practical feasibility was demonstrated.Accordingly, in July 2000, an Indicative Report, analyzing retrospectively collecteddata from five Victorian Cardiac surgical Units, was published. The Reportdemonstrated that a central agency could collect and generate comparativeperformance information. Significantly, it also confirmed that such information,harvested from several sources, each with their own collection systems anddefinitions, inevitably produced inaccurate and unreliable data.Consequently, the ASCTS established a National Database Steering Committeeand four subcommittees: 1. Dataset and Definitions. 2. Data Analysis. 3. Privacy and Ethics.ASCTS Surgeon’s Comprehensive report 2001-2002 Page 7 of 8312/6/2010
    • 4. Peer Review and Quality Assurance.The deliberations of these Committees were presented and discussed at aNational Cardiac Surgery Database workshop convened in Melbourne, in August,2000.Further encouragement for the project was provided by the publishing ofunadjusted ‘league tables’ in the United States and United Kingdom and byevidence from the UK of the deleterious consequences of the absence of aNational surgical outcome review. Specifically, the Victorian Governmentcommissioned a Health Services Policy Review Discussion Paper which waspublished in 1999. Recommendation 24 of the Review stated “that theCommonwealth and States collaborate to develop a set of risk-adjusted,comprehensive, consumer-focused and current clinical performance indicators”.The Victorian Government grant facilitated the creation of a Business Plan,produced by Melbourne Information Services and the appointment of the Cardio-Vascular Research Unit of the Baker Heart Research Institute as projectmanagers. The Project was coordinated by a Steering Committee consisting ofrepresentatives from the participating Units and overseen by the Board ofAustralasian Cardiac Surgical Research Institution Limited.The First Annual Report of the ASCTS DatabaseThe Report presents the results of prospectively collected data from all sixVictorian Public Hospital Cardiac Surgical Units, from August 2001 to December2002 inclusive. The methodology of data acquisition was rigorous. Identicalinformation, in terms of Dataset and Definitions, was obtained from all Units.The Report demonstrates that the outcomes of Victorian Units are acceptable, withno significant overall performance differences between units.The FutureInclusion of All Australasian Cardiac Surgery UnitsThe ASCTS Database Project is now a reality. Its feasibility is demonstrated by thispilot project, which happened to take place in Victoria.As an integral component of the Project, a Software Program for data recordingand reporting was generated. This would facilitate the adoption of the Database byany Unit. The next task is to progressively include all Australasian Units, in both thePublic and Private sectors. All Units have expressed keen interest. However, lackof funding is a major impediment. Initiatives to obtain financial support have beeninstigated.ResourcesA National project of this nature is expensive. Continued and stable funding isessential for data managers and their training, computer systems, the maintenanceof database software, data transmission, validation processes, analysis andreporting programs and for central database personnel. Demonstrably, these costsare eclipsed by the benefits of the Database in terms of improved patientoutcomes.ASCTS Surgeon’s Comprehensive report 2001-2002 Page 8 of 8312/6/2010
    • Modification of the Dataset and DefinitionsA dataset such as this must evolve. The current dataset was based on the USSociety of Thoracic Surgeons (STS) model. Its application during the initial phaseof the program has demonstrated necessary modifications consistent withAustralasian requirements and progress in surgical techniques. Therefore, a reviewof the dataset and definitions will proceed at the end of this year. Nonetheless, thebroad thrust of the program will be consistent with the established STS, UK andECSUR Databases, in order to allow comparison.Risk Adjustment and Risk Prediction ModelsSuch models, based on a variety of statistical techniques, have been developed bythe UK and particularly the US STS Database Programs. Each recognizes thatonly models based on local data can validly reflect variation in clinical presentationand therefore outcomes. The development of such models requires large numbersof patients. Such numbers can only be acquired in a timely fashion if all Unitscontribute to the Program.AcknowledgmentsThis Report was made possible by the vision and dedication of the members of theseveral Committees of the ASCTS, by the continuing involvement of allparticipating surgeons and allied health professionals, by the expertise andattention to detail of data managers and by the consistently superb contribution ofthe members of the Central Data Registry.Finally, the ASCTS is grateful to DHS Victoria for its financial support and for itsclose and understanding involvement with the Project.Gilbert C. Shardey FRACSChairman, ASCTS Cardiac Surgery Database Steering CommitteeASCTS Surgeon’s Comprehensive report 2001-2002 Page 9 of 8312/6/2010
    • ASCTS Surgeon’s Comprehensive report 2001-2002 Page 10 of 8312/6/2010
    • Public ReportPublic ReportThis concise Public Report on the quality of cardiac surgical care provides accurateinformation on the risk associated with cardiac surgery. A similar report is providedfor distribution to each individual participating cardiac surgery unit by the VictorianDepartment of Human Services.The Public Report covers some of the demographic and clinical characteristics ofpeople receiving cardiac surgery including information on:• Demographic characteristics of patients undergoing surgery in Victorian Cardiac Surgery Units including: • Age and Gender distribution • Risk Factors • Aspects of Cardiac History• Types of operations undertaken in Victorian Cardiac Surgery Units• Raw, unadjusted Mortality by type of operation for procedures performed in Victoria, the USA and the UK• Clinical Urgency Status of patients undergoing Surgery in Victorian Cardiac Surgery Units• Mortality by patient clinical urgency status• Mortality by patient age for isolated CABGThe following key performance indicators have been identified for monitoring aspart of the report to the Victorian Government:ASCTS Surgeon’s Comprehensive report 2001-2002 Page 11 of 8312/6/2010
    • • 30 day all-cause risk-adjusted mortality following isolated CABG• Post-operative deep sternal infections following isolated CABG• Post-operative haemorrhage requiring return to theatre following isolated CABG• Length of ICU Stay following isolated CABG• Length of Intubation time following isolated CABGAll six Victorian Public Hospital Adult Cardiac Surgery Units have participated inthe program. They are The Austin and Repatriation Medical Centre, GeelongHospital, Monash Medical Centre – Clayton, Royal Melbourne Hospital, StVincent’s Hospital and The Alfred.Demographic CharacteristicsThe majority (63%) of people receiving cardiac surgery services were aged 60 to80 years (Figure 1). Females made up 30% of cardiac surgery patients. In termsof risk factors, 18% of those having cardiac surgery were current smokers, 28%had diabetes and 66% had high blood pressure requiring treatment. Othercharacteristics of patients undergoing treatment at each of the hospitals areindicated in Table 1.ASCTS Surgeon’s Comprehensive report 2001-2002 Page 12 of 8312/6/2010
    • 80 + yrs7% < 40 yrs70-79 yrs 4%33% 40-49 yrs 7% 50-59 yrs 20% 60-69 yrs 30% Figure 1: Age distribution of all patients having Cardiac Surgery in Victorian Public Hospitals, 1 August 2001 to 31 July 2002 ASCTS Surgeon’s Comprehensive report 2001-2002 Page 13 of 83 12/6/2010
    • Table 1: Characteristics of Patients undergoing Surgery in Victorian Cardiac Surgical Units: 2001 - 2002 Hospital A B C D E F TotalCharacteristicTotal number of Cases included 627 507 418 334 344 760 2990Cases included in this analysis* 621 502 417 334 341 759 2974Age and Sex DistributionMean Age (yr) 65 66 63 64 67 65 65>80 yrs (%) 9 5 2 7 7 8 7Males (%) 72 71 70 72 67 70 70DOSAElective Day of Surgery Admission (%) 52 10 48 12 5 64 38Risk FactorsCurrent Smoker (%) 17 24 19 13 18 18 18Diabetes (%) 28 25 28 25 25 32 28Hypertension(%) 59 66 66 63 55 79 66Cerebrovascular disease (%) 8 10 9 14 12 12 11Peripheral Vascular Disease (%) 14 11 12 9 12 11 12Cardiac HistoryPrevious Cardiac Intervention (%) 21 13 14 20 18 17 17 Previous CABG (%) 8 4 3 5 4 4 5 Previous Valve (%) 3 1 1 3 2 1 2 Previous PTCA / Stent (%) 9 8 8 12 11 8 9Myocardial Infarction (%) 42 43 41 40 46 43 43 - of which <21days (%) 35 36 32 29 37 26 32Congestive Heart Failure (%) 32 31 16 23 28 33 28*16 Procedures were excluded where 1) the procedure was a second procedure for a patient on the same day (50%), 2) where data on 30-day mortality, type of procedure or urgency statuswere missing (44%) or 3) where the patient had opted-off the database (6%)ASCTS Surgeon’s Comprehensive report 2001-2002 Page 14 of 8312/6/2010
    • Types of OperationsProcedures that are performed in the cardiac surgery units include CoronaryArtery Bypass Graft Surgery (CABG) (68% of procedures), heart valve repair orreplacement (12%), a combination of both procedures (8%) with the remaining12% of procedures being made up of all other less common cardiac proceduresor combinations of procedures.Mortality by Type of OperationThe mortality rate for each of the three major groups of procedures is lower inVictoria than that reported in published data from the USA and UK. Themortality rate within thirty days of surgery for isolated CABG is around 2% (orone death for every fifty patients). It should be noted that the “other” category,which comprises only 12% of operations, includes a wide range of procedures,many of which are associated with high risk. The overall mortality rate for thismixed group of procedures is around 10% (Figure 2).ASCTS Surgeon’s Comprehensive report 2001-2002 Page 15 of 8312/6/2010
    • 10 ASCTS UK Unadjusted mortality rate (%) USA 8 6 4 2 0 Isolated CABG Valve(s) Valve(s) + CABG Procedure TypeFigure 2: Mortality rate for cardiac surgery by procedure group, USA, UK and Victorian Public Hospitals, 1 August 2001 to 31 July 2002ASCTS Surgeon’s Comprehensive report 2001-2002 Page 16 of 8312/6/2010
    • Clinical Urgency Status for Isolated CABG and related mortalityOf the 2022 people undergoing isolated CABG between 1 August 2001 and 31July 2002, 64% of people were admitted as elective patients, 30% of peoplewere operated upon as urgent cases, 5% of people were operated on asemergency (that is within 24 hours of presentation) and <1% of people whereoperated on as “salvage” procedures, that is where a life-threatening event hadalready occurred (Figure 3).The mortality rate for each of these patient groups is shown in Figure 4. Themortality rate for people undergoing elective surgery is approximately one-tenththe rate for emergency surgery.Patient Age and Related MortalityOlder patients have less capacity to sustain cardiac surgery. This is reflected inmortality rates for elective isolated CABG surgery with the increasing mortalityrate with increasing age shown in Figure 5. Despite this increase with age themortality rate for people 80 years and older peaks at 4% or approximately onedeath per 25 people undergoing an operation.ASCTS Surgeon’s Comprehensive report 2001-2002 Page 17 of 8312/6/2010
    • ASCTS Patient Status Data from all participating hospitals (%) SalvageSalvage 0.8% EmergencyEmergency 5.2% UrgentUrgent 29.8% Elective Elective 64.2% Public Report Figure 3: Status of Patients undergoing Isolated CABG procedures, Victorian Public Hospitals, 1 August 2001 to 31 July 2002 ASCTS Surgeon’s Comprehensive report 2001-2002 Page 18 of 83 12/6/2010
    • 14 12 10 Mortality Rate (%) 8 6 4 2 0 Elective Urgent Emergency Patient StatusFigure 4: Mortality rate for isolated CABG surgery by clinical urgency status of thepatient, Victorian Public Hospitals, 1 August 2001 to 31 July 2002ASCTS Surgeon’s Comprehensive report 2001-2002 Page 19 of 8312/6/2010
    • 4 3 Mortality Rate (%) 2 1 0 <40 40-49 50-59 60-69 70-79 80+ Age GroupFigure 5: Mortality rate following elective isolated CABG surgery by Age Group,Victorian Public Hospitals, 1 August 2001 to 31 July 2002ASCTS Surgeon’s Comprehensive report 2001-2002 Page 20 of 8312/6/2010
    • Performance IndicatorsComparison of Mortality for isolated CABG by Surgical UnitThe comparison between mortality rates (within 30 days of isolated CABG) forall Victorian Public Hospital Cardiac Surgery Units as well as UK and USAbenchmarks is shown in Figure 6. The average Victorian Cardiac Surgerymortality rate is below the rate for both the UK and the USA. Two VictorianCardiac Surgery Units had a mortality rate above the USA benchmark andthree hospitals had a rate above the UK benchmark. All hospitals in Victoria fellwithin 3 standard deviations of the mean and are therefore not significantlydifferent in 30 day mortality outcomes.ASCTS Surgeon’s Comprehensive report 2001-2002 Page 21 of 8312/6/2010
    • 5 Actual Risk-adjusted* 4 Mortality (%) 3 USA 2000 Benchmark (Actual) UK 2000 Benchmark (Actual) 2 1 0 A B C D E F AVE Participating Unit * Risk-adjusted using the Euroscore ModelFigure 6: The Mortality rate within 30 days of isolated Coronary Artery Bypass Graft Surgery (CABG), Victorian Public Hospitals, 1August 2001 to 31 July 2002. The average mortality rate for UK and USA hospitals are shown with the large and small dashed linesrespectively.ASCTS Surgeon’s Comprehensive report 2001-2002 Page 22 of 8312/6/2010
    • 10 Elective Non Elective Mortality Rate (%) 8 6 4 2 0 A B C D E F Hospital Unit Number of deaths: 4 4 4 7 3 4 0 2 2 8 3 2Figure 7: The Mortality rate within 30 days of Coronary Artery Bypass Graft Surgery (CABG), elective vs non-elective procedures,Victorian Public Hospitals, 1 August 2001 to 31 July 2002. Numbers represent the actual numbers of deaths in each categoryASCTS Surgeon’s Comprehensive report 2001-2002 Page 23 of 8312/6/2010
    • Post-operative Deep Sternal Infection and HaemorrhageDeep sternal infection is a serious complication of CABG surgery. Thiscomplication is rare (all units having an incidence of ≤1%), and hence is affectedby a small amount of random variation. Post-operative haemorrhage requiringreturn to the operating theatre is not as serious a complication, but does impact ontheatre and blood bank utilisation. The deep sternal infection and return to theatrefor post-operative haemorrhage complication rates post CABG for each of theCardiac Surgery Units are shown in Figures 8 and 9 respectively. Although therates appear to differ between Cardiac Surgery Units, all Units have very low ratesand have performed well within the expected statistical limits. Whilst there is noevidence of a statistical difference in these complication rates between CardiacSurgery Units, it is important to note that one hospital has reported no cases ofdeep sternal infection over the 12 month period. This should be closely examinedfurther for strategies to improve the already low rates reported in other Units.Length of Stay and Mechanical VentilationThe length of stay in ICU and the period of time that a patient requires mechanicalventilation (support to breathe) post-operatively are important cost measures ofcardiac surgical care. The need for mechanical ventilation is dependent on theextent and complexity of the cardiac surgery being undertaken, the patient’s ageand the presence of obesity or pre-existing respiratory disease. The period of timefor which mechanical ventilation is required and the time spent in ICU areinterdependent, since mechanical ventilation is the most common reasonnecessitating prolonged ICU care. Patients will usually require mechanicalventilation after cardiac surgery. On occasions this will be for long periods of timedepending on the patient’s condition. The mean and median duration of time spentASCTS Surgeon’s Comprehensive report 2001-2002 Page 24 of 8312/6/2010
    • in ICU and spent intubated (on mechanical ventilation) in each Cardiac SurgeryUnit are shown in figures 10 and 11 respectively. The median times (which varylittle between Units) are more accurate indicators of each Units performance, asoutliers with prolonged times can distort the mean values. 1.2 1.0 0.8 % procedures 0.6 0.4 0.2 0.0 A B C D E F AVE Surgical UnitNumber of cases: 2 1 2 2 0 2 9** - total numberFigure 8: Deep sternal infection rate following isolated CABG, Victorian PublicHospitals, 1 August 2001 to 31 July 2002ASCTS Surgeon’s Comprehensive report 2001-2002 Page 25 of 8312/6/2010
    • 3.5 3.0 2.5% procedures 2.0 1.5 1.0 0.5 0.0 A B C D E F AVE Surgical Unit Number of cases: 12 10 4 2 7 8 43* * - total number Figure 9: Rate of Post-operative haemorrhage requiring return to theatre following isolated CABG, Victorian Public Hospitals, 1 August 2001 to 31 July 2002 ASCTS Surgeon’s Comprehensive report 2001-2002 Page 26 of 83 12/6/2010
    • 60 Mean Median 50 40Hours 30 20 10 0 A B C D E F AVE Surgical Unit Figure 10: Average and Median length of ICU stay in hours post isolated CABG, Victorian Public Hospitals, 1 August 2001 to 31 July 2002 ASCTS Surgeon’s Comprehensive report 2001-2002 Page 27 of 83 12/6/2010
    • 20 Mean Median 15Hours 10 5 0 A B C D E F AVE Surgical Unit Figure 11: Average and Median length of Intubation time in hours post isolated CABG, Victorian Public Hospitals, 1 August 2001 to 31 July 2002 ASCTS Surgeon’s Comprehensive report 2001-2002 Page 28 of 83 12/6/2010
    • SummaryIn this report, it can be seen that the outcomes from cardiac surgery in VictorianPublic Hospitals are as good or better than equivalent overseas results, and thatthere are no significant differences in the performance outcomes between theindividual units.It is expected that the introduction of this database will result in furtherimprovements in the quality and outcome of care in Victorian patients havingcardiac surgery operations in the Public Hospital system.ASCTS Surgeon’s Comprehensive report 2001-2002 Page 29 of 8312/6/2010
    • ASCTS Surgeon’s Comprehensive report 2001-2002 Page 30 of 8312/6/2010
    • Comprehensive Surgeon’s ReportComprehensive Surgeon’s ReportThis Report provides a more comprehensive assessment of the data than thePublic Report. It gives the opportunity to look for emerging trends within the data,and to drill down to look for inter-relationships between variables.The Surgeon’s Report includes further data on the following:• Valve data This section includes data on valve procedures, performed both with and without Coronary Artery Bypass Graft. Data is presented on: Procedure type Prosthesis use Mortality Post-operative complications Post-operative indicators• Isolated CABG data This section presents data for Isolated Coronary Artery Bypass Graft procedures. Data is presented on: Grafts Mortality Post-operative complications Post-operative indicators• ‘Other’ Group data This section provides outcome data on operations other than valve and Coronary Artery Bypass Graft procedures, or where a combination of procedures not covered in the previous section were conducted in the same theatre episode.• Factors Contributing to Outcomes in the Whole Population This section provides outcome data for all cardiac surgery procedures in relation to a number of risk factors.ASCTS Surgeon’s Comprehensive report 2001-2002 Page 31 of 8312/6/2010
    • Valve data SINGLE VALVE OPERATIONS WITHOUT CABG WITH CABG Initial Redo Total Total No. Died % No. Died % No. Died % No. Died %AorticAnnuloplasty only 0 - - 0 - - 0 - - 1 0 0.0Replacement 189 5 2.6 11 1 9.1 200 6 3.0 176 9 5.1Root reconstruction 15 0 0.0 1 1 100.0 16 1 6.3 3 0 0.0with valve conduitResuspension 0 - - 1 1 100.0 1 1 100.0 0 - -Repair /Reconstruction with 0 - - 0 - - 0 - - 1 0 0.0annuloplastyRepair /Reconstruction 4 0 0.0 1 0 0.0 5 0 0.0 0 - -without annuloplastyRoot reconstruction 2 0 0.0 0 - - 2 0 0.0 1 0 0.0with valve sparingResection sub aortic 1 0 0.0 0 - - 1 0 0.0 0 - -stenosisAortic total 211 5 2.4 14 3 21.4 225 8 3.6 182 9 4.9MitralAnnuloplasty only 5 0 0.0 0 - - 5 0 0.0 6 0 0.0Replacement 48 1 2.1 6 1 16.7 54 2 3.7 26 0 0.0Repair /Reconstruction with 37 0 0.0 0 - - 37 0 0.0 17 0 0.0annuloplastyRepair /Reconstruction 0 - - 1 0 0.0 1 0 0.0 0 - -without annuloplastyMitral total 89 1 1.1 7 1 14.3 97 2 2.1 49 0 0.0TricuspidReplacement 2 0 0.0 0 - - 2 0 0.0 0 - -Repair /Reconstruction with 1 0 0.0 0 - - 1 0 0.0 0 - -annuloplastyTricuspid total 3 0 0.0 0 - - 3 0 0.0 0 - -PulmonaryReplacement 2 0 0.0 0 - - 2 0 0.0 0 - -Pulmonary total 2 0 0.0 0 - - 2 0 0.0 0 - -Total single valve 306 6 2.0 21 4 19.0 327 10 3.1 231 9 3.9 MULTIPLE VALVE OPERATIONSDouble valvesMitral & Aortic 18 1 5.6 1 1 100.0 19 2 10.5 3 0 0.0Mitral & Tricuspid 4 1 25.0 2 1 50.0 6 2 33.3 2 0 0.0Aortic & Tricuspid 2 0 0.0 0 - - 2 0 0.0 0 0 0.0Other double valves 6 0 0.0 2 0 0.0 8 0 0.0 0 0 0.0Double total 30 2 6.7 5 2 40.0 35 4 11.4 5 0 0.0Triple total 3 0 0.0 1 0 0.0 4 0 0.0 0 - -Total Multiple 33 2 6.1 6 2 33.3 39 4 10.3 5 0 0.0Total single 306 6 2.0 21 4 19.0 327 10 3.1 231 9 3.9Total valve 339 8 2.4 27 6 22.2 366 14 3.8 238 10 4.2ASCTS Surgeon’s Comprehensive report 2001-2002 Page 32 of 8312/6/2010
    • Valve data VALVE BY PROSTHESIS TYPESingle valve without CABG Valve Position Aortic Mitral Tricuspid Pulmonaryn 225 97 3 2None 3.6% 2.1% 0.0% 0.0%Mechanical 34.7% 47.4% 0.0% 0.0%Bioprosthesis 56.4% 6.2% 66.7% 50.0%Homograft / Allograft 4.5% 1.0% 0.0% 50.0%Autograft 0.0% 0.0% 0.0% 0.0%Ring/Annuloplasty 0.9% 43.3% 33.3% 0.0%Single valve with CABG Valve Position Aortic Mitral Tricuspid Pulmonaryn 182 49 0 0None 0.5% 0.0% - -Mechanical 25.3% 38.8% - -Bioprosthesis 74.2% 12.2% - -Homograft / Allograft 0.0% 2.0% - -Autograft 0.0% 0.0% - -Ring/Annuloplasty 0.0% 46.9% - -Single valve with or without CABG Valve Position Aortic Mitral Tricuspid Pulmonaryn 407 146 3 2None 2.2% 1.4% 0.0% 0.0%Mechanical 30.5% 44.5% 0.0% 0.0%Bioprosthesis 64.4% 8.2% 66.7% 50.0%Homograft / Allograft 1.0% 1.4% 0.0% 50.0%Autograft 1.5% 0.0% 0.0% 0.0%Ring/Annuloplasty 0.5% 44.5% 33.3% 0.0%ASCTS Surgeon’s Comprehensive report 2001-2002 Page 33 of 8312/6/2010
    • Valve dataVALVE BY AETIOLOGY AND AGEAll Aortic valve procedures Age Group <40 40-49 50-59 60-69 70-79 80+ yrs years yrs yrs yrs yrs Totaln 25 31 60 133 197 81 527Rheumatic 4.0% 9.7% 10.0% 11.3% 6.6% 3.7% 7.8%Congenital 36.0% 25.8% 25.0% 21.1% 9.1% 4.9% 15.6%Ischaemic 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%Idiopathic Calcific 0.0% 19.4% 31.7% 42.9% 60.9% 71.6% 49.3%Myxomatous degeneration 4.0% 6.5% 3.3% 9.8% 9.1% 12.3% 8.7%Failed prior repair 0.0% 3.2% 0.0% 0.0% 0.0% 0.0% 0.2%Prosthetic valve failure 4.0% 0.0% 0.0% 0.0% 1.5% 1.2% 0.9%Peri-prosthetic leak 0.0% 0.0% 1.7% 0.0% 0.5% 0.0% 0.4%Prosthetic valve thrombosis 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%Active infection 20.0% 9.7% 11.7% 3.0% 3.6% 1.2% 5.1%Previous infection 8.0% 0.0% 0.0% 1.5% 0.0% 0.0% 0.8%Marfans 8.0% 3.2% 0.0% 0.8% 0.0% 0.0% 0.8%Annuloaortic ectasia 0.0% 0.0% 6.7% 3.8% 2.5% 2.5% 3.0%Other degenerative disease 4.0% 6.5% 0.0% 0.8% 1.5% 0.0% 1.3%Dissection 4.0% 12.9% 8.3% 4.5% 0.5% 0.0% 3.2%Tumour 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%Trauma 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%Iatrogenic 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%Other 4.0% 0.0% 1.7% 0.8% 2.5% 1.2% 1.8%Not specified 4.0% 3.2% 0.0% 0.0% 1.5% 1.2% 1.1%ASCTS Surgeon’s Comprehensive report 2001-2002 Page 34 of 8312/6/2010
    • Valve data VALVE BY AETIOLOGY AND AGEAll Mitral valve procedures Age Group <40 40-49 50-59 60-69 70-79 80+ yrs years yrs yrs yrs yrs Totaln 18 14 31 73 73 11 220Rheumatic 5.6% 42.9% 35.5% 28.8% 17.8% 9.1% 24.1%Congenital 11.1% 0.0% 3.2% 0.0% 1.4% 0.0% 1.8%Ischaemic 0.0% 0.0% 3.2% 9.6% 19.2% 0.0% 10.0%Idiopathic Calcific 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%Myxomatous degeneration 16.7% 35.7% 29.0% 47.9% 46.6% 54.5% 41.8%Failed prior repair 11.1% 7.1% 3.2% 0.0% 2.7% 0.0% 2.7%Prosthetic valve failure 0.0% 0.0% 0.0% 0.0% 1.4% 0.0% 0.5%Peri-prosthetic leak 5.6% 0.0% 3.2% 1.4% 1.4% 9.1% 2.3%Prosthetic valve thrombosis 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%Active infection 33.3% 7.1% 9.7% 1.4% 2.7% 9.1% 6.4%Previous infection 5.6% 0.0% 3.2% 1.4% 0.0% 0.0% 1.4%Marfans 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%Other degenerative disease 0.0% 0.0% 0.0% 1.4% 1.4% 0.0% 0.9%Dissection 0.0% 0.0% 0.0% 1.4% 0.0% 0.0% 0.5%Tumour 5.6% 0.0% 0.0% 0.0% 0.0% 0.0% 0.5%Trauma 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%Iatrogenic 0.0% 0.0% 0.0% 0.0% 1.4% 0.0% 0.5%Other 5.6% 0.0% 9.7% 5.5% 1.4% 9.1% 4.5%Not specified 0.0% 7.1% 0.0% 1.4% 2.7% 9.1% 2.3%ASCTS Surgeon’s Comprehensive report 2001-2002 Page 35 of 8312/6/2010
    • Valve dataMortalitySUMMARY Number of 30 day Mortality 30 day Mortality Operations (n) (%)Valves onlyAortic Valve Surgery only 225 8 3.6% Aortic Valve Replacement only 200 6 3.0%Mitral Valve Surgery only 99 2 2.0% Mitral Valve Replacement only 54 2 3.6% MV Repair only 38 0 0.0%Tricuspid Valve Surgery only 3 0 0.0%Pulmonary Valve Surgery only 2 0 0.0%Aortic & Mitral Valve Surgery only 19 2 10.5%Mitral & Tricuspid Valve Surgery only 6 2 33.3%Aortic & Tricuspid Valve Surgery only 2 0 0.0%Other Doubles 8 0 0.0%Triples 4 0 0.0%Valves & CABG onlyAortic Valve Surgery & CABG only 182 9 4.9% Aortic Valve Replacement & CABG only 176 9 5.1%Mitral Valve Surgery & CABG only 49 0 0.0% Mitral Valve Replacement & CABG only 26 0 0.0% Mitral Valve Repair & CABG only 17 0 0.0%Aortic & Mitral Valve Surgery & CABG only 3 0 0.0%Mitral & Tricuspid Valve Surgery & CABG only 2 0 0.0%TOTAL Valve 604 24 4.0%(with or without CABG) onlyASCTS Surgeon’s Comprehensive report 2001-2002 Page 36 of 8312/6/2010
    • Valve data SINGLE VALVE – INITIAL OPERATION ONLY Mortality BY CARDIAC SURGERY UNIT Aortic Valve Replacement by Cardiac Surgery Unit 200 (5) Without CABG (9) With CABG (n) number of 30 day mortalities 150Number of cases 100 (0) (4) 50 (0) (1) (1) (1) (2) (2) (0) (0) (1) (2) 0 A B C D E F Total Cardiac Surgery Unit Mitral Valve Replacement by Cardiac Surgery Unit 60 Without CABG With CABG 50 (1) (n) number of 30 day mortalities Number of cases 40 30 (0) 20 (0) (0) (0) 10 (0) (0) (1) (0) (0) (0) (0) (0) (0) 0 A B C D E F Total Cardiac Surgery Unit ASCTS Surgeon’s Comprehensive report 2001-2002 Page 37 of 83 12/6/2010
    • Valve dataMortalityBY AGESingle valve with or without CABG 30 day Mortality (mortality/n %) Age Group <40 years 40-49 yrs 50-59 yrs 60-69 yrs 70-79 yrs 80+ yrsAortic 1/12 8.3% 0/16 0.0% 0/40 0.0% 3/99 3.0% 6/172 3.5% 7/68 10.3%Mitral 0/6 0.0% 0/7 0.0% 0/22 0.0% 0/50 0.0% 2/53 3.8% 0/8 0.0%Tricuspid 0/1 0.0% 0/1 0.0% 0/0 - 0/1 0.0% 0/0 - 0/0 -Pulmonary 0/2 0.0% 0/0 - 0/0 - 0/0 - 0/0 - 0/0 -Total 1/21 4.8% 0/24 0.0% 0/62 0.0% 3/150 2.0% 8/225 3.6% 7/76 9.2%AVR + CABG only 30 day Mortality (mortality/n %) Age Group <40 years 40-49 yrs 50-59 yrs 60-69 yrs 70-79 yrs 80+ yrs 0/0 - 0/2 0.0% 0/8 0.0% 3/41 6.8% 1/91 1.1% 5/32 15.2%BY CLINICAL STATUSAVR + CABG only 30 day Mortality (mortality/n %) Operative Status Elective Urgent Emergency Salvage 6/136 4.4% 3/36 8.3% 0/1 0.0% 0/1 0.0%AVR + CABG only 30 day Mortality (mortality/n %) Redo Pre-op creatinine Yes No <=0.2 >0.2 1/15 6.7% 8/159 5.0% 7/164 4.3% 2/10 20.0%ASCTS Surgeon’s Comprehensive report 2001-2002 Page 38 of 8312/6/2010
    • Valve data Morbidity BY VALVE POSITION Single valve – Valve onlyPost-operative complications Valve Position Tricuspid or Aortic Mitral Pulmonary Totaln 225 97 5 327New Renal Failure 5.3% 2.1% 0.0% 4.3%Cerebrovascular complication 3.1% 1.0% 0.0% 2.4% Permanent Stroke 2.2% 1.0% 0.0% 1.8% Transient Stroke 0.4% 0.0% 0.0% 0.3% Continuous Coma 0.4% 0.0% 0.0% 0.3%Deep Sternal Infection 0.0% 0.0% 0.0% 0.0%Septicaemia 0.9% 1.0% 0.0% 0.9%Return to theatre (all cause) 9.8% 7.2% 0.0% 8.9%Re-op for Bleeding 6.7% 5.2% 0.0% 6.1%Peri-operative AMI 0.4% 0.0% 0.0% 0.3%New Cardiac Arrhythmia 36.9% 34.0% 0.0% 35.5%Pneumonia 5.3% 5.2% 0.0% 5.2%GIT complication 1.8% 1.0% 0.0% 1.5%Multi-system Failure 0.9% 1.0% 0.0% 0.9%Anticoagulant complication 0.4% 1.0% 0.0% 0.6%Red Blood Cells transfused 47.6% 38.1% 40.0% 44.6%Non-RBC blood products 28.9% 22.7% 0.0% 26.6%Post-operative indicators Intubation Time <=10hrs 57.9% 70.8% 80.0% 62.1% 10-20hrs 30.3% 24.0% 20.0% 28.3% >20hrs 11.8% 5.2% 0.0% 9.6%Post-op Length <= 5 days 19.1% 15.5% 0.0% 17.7%of Stay 5-10 days 59.6% 59.8% 80.0% 59.9% >10 days 21.3% 24.7% 20.0% 22.3%Intensive Care <=24hrs 54.3% 59.8% 40.0% 55.7%Stay >24hrs – 38.1% 35.1% 60.0% 37.5% 4 days > 4 days 7.6% 5.2% 0.0% 6.8%ASCTS Surgeon’s Comprehensive report 2001-2002 Page 39 of 8312/6/2010
    • Valve dataMorbidityBY VALVE POSITIONSingle valve – Valve with CABG onlyPost-operative complications Valve Position Tricuspid or Aortic Mitral Pulmonary Totaln 182 49 0 231New Renal Failure 12.1% 8.2% - 11.3%Cerebrovascular complication 3.3% 8.2% - 4.3% Permanent Stroke 1.1% 6.1% - 2.2% Transient Stroke 2.2% 0.0% - 1.7% Continuous Coma 0.0% 2.0% - 0.4%Deep Sternal Infection 0.5% 2.0% - 0.9%Septicaemia 2.7% 4.1% - 3.0%Return to theatre (all cause) 5.5% 10.2% - 6.5%Re-op for Bleeding 3.8% 8.2% - 4.8%Peri-operative AMI 2.2% 0.0% - 1.7%New Cardiac Arrhythmia 42.9% 44.9% - 43.3%Pneumonia 7.7% 14.3% - 9.1%GIT complication 3.8% 2.0% - 3.5%Multi-system Failure 3.3% 2.0% - 3.0%Anticoagulant complication 2.2% 2.0% - 2.2%Red Blood Cells transfused 66.5% 65.3% - 66.2%Non-RBC blood products 45.6% 36.7% - 43.7%Post-operative indicators Intubation Time <=10hrs 47.8% 34.7% - 45.0% 10-20hrs 34.6% 26.5% - 32.9% >20hrs 17.6% 38.8% - 22.1%Post-op Length <= 5 days 8.8% 10.2% - 9.1%of Stay 5-10 days 53.3% 44.9% - 51.5% >10 days 37.9% 44.9% - 39.4%Intensive Care <=24hrs 36.3% 28.6% - 34.6%Stay >24hrs – 48.9% 49.0% - 48.9% 4 days > 4 days 14.8% 22.4% - 16.5%ASCTS Surgeon’s Comprehensive report 2001-2002 Page 40 of 8312/6/2010
    • Valve data Morbidity BY VALVE POSITION Single valve – Valve with or without CABG onlyPost-operative complications Valve Position Tricuspid or Aortic Mitral Pulmonary Totaln 407 146 5 558New Renal Failure 9.8% 4.1% 0.0% 7.2%Cerebrovascular complication 3.2% 3.4% 0.0% 3.2% Permanent Stroke 1.7% 2.7% 0.0% 2.0% Transient Stroke 1.2% 0.0% 0.0% 0.9% Continuous Coma 0.2% 0.7% 0.0% 0.3%Deep Sternal Infection 0.2% 0.7% 0.0% 0.3%Septicaemia 1.7% 2.1% 0.0% 1.8%Return to theatre (all cause) 7.9% 11.0% 0.0% 7.9%Re-op for Bleeding 5.4% 6.2% 0.0% 5.6%Peri-operative AMI 1.2% 0.0% 0.0% 0.9%New Cardiac Arrhythmia 39.6% 37.7% 0.0% 38.7%Pneumonia 6.4% 8.2% 0.0% 6.8%GIT complication 2.7% 1.4% 0.0% 2.3%Multi-system Failure 2.0% 1.4% 0.0% 1.8%Anticoagulant complication 1.2% 1.4% 0.0% 1.3%Red Blood Cells transfused 56.0% 47.3% 40.0% 53.6%Non-RBC blood products 36.4% 27.4% 0.0% 33.7%Post-operative indicators Intubation Time <=10hrs 52.8% 58.2% 80.0% 54.5% 10-20hrs 31.9% 26.7% 20.0% 29.9% >20hrs 14.3% 16.4% 0.0% 14.7%Post-op Length <= 5 days 14.5% 13.7% 0.0% 14.2%of Stay 5-10 days 56.8% 54.8% 80.0% 56.5% >10 days 28.7% 31.5% 20.0% 29.4%Intensive Care <=24hrs 45.9% 49.3% 40.0% 46.8%Stay >24hrs – 42.8% 39.7% 60.0% 42.1% 4 days > 4 days 10.8% 11.0% 0.0% 10.8%ASCTS Surgeon’s Comprehensive report 2001-2002 Page 41 of 8312/6/2010
    • Valve dataMorbidityBY VALVE POSITION AND CARDIAC SURGERY UNITSingle valve – Valve only New Renal Failure by Valve Position and Cardiac Surgery Unit 25 Aortic (5) Mitral 20 (n) number of cases with the complication 15 % (1) No. cases 10 (4) (12) Aortic 5 (1) (1) (1) (1) (2) A 49 0 (0) (0) (0) (0) (0) B 45 A B C D E F Total C 33 Permanent Stroke by Valve Position and Cardiac Surgery Unit D 23 10 E 25 Aortic Mitral F 50 (2) 8 (n) number of cases with the complication Total 225 6 % (1) (1) 4 Mitral (1) (5) (1) 2 A 15 (1) B 24 0 (0) (0) (0) (0) (0) (0) (0) C 13 A B C D E F Total D 8 Re-op for bleeding by Valve Position and Cardiac Surgery Unit E 12 F 25 16 Aortic (7) Mitral 14 (3) Total 97 (1) (n) number of cases with the complication 12 10 % 8 (2) (1) (1) (15) 6 (5) (2) (1) (1) 4 (1) 2 (0) (0) 0 A B C D E F Total Cardiac Surgery UnitASCTS Surgeon’s Comprehensive report 2001-2002 Page 42 of 8312/6/2010
    • Valve data Morbidity BY AGE Single valve – Valve onlyPost-operative complications Age Group <40 40-49 50-59 60-69 70-79 80+ yrs years yrs yrs yrs yrs Totaln 21 22 47 87 109 41 327New Renal Failure 0.0% 0.0% 0.0% 1.1% 7.3% 12.2% 4.3%Cerebrovascular complication 0.0% 4.5% 0.0% 2.3% 3.7% 2.4% 2.4% Permanent Stroke 0.0% 4.5% 0.0% 1.1% 2.8% 2.4% 1.8% Transient Stroke 0.0% 0.0% 0.0% 1.1% 0.0% 0.0% 0.3% Continuous Coma 0.0% 0.0% 0.0% 0.0% 0.9% 0.0% 0.3%Deep Sternal Infection 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%Septicaemia 4.8% 0.0% 0.0% 0.0% 0.9% 2.4% 0.9%Return to theatre (all cause) 23.8% 9.1% 6.4% 9.2% 8.3% 4.9% 8.9%Re-op for Bleeding 14.3% 0.0% 6.4% 6.9% 6.4% 2.4% 6.1%Peri-operative AMI 0.0% 0.0% 0.0% 0.0% 0.9% 0.0% 0.3%New Cardiac Arrhythmia 19.0% 27.3% 27.7% 39.1% 37.6% 43.9% 35.5%Pneumonia 9.5% 0.0% 6.4% 1.1% 6.4% 9.8% 5.2%GIT complication 4.8% 0.0% 2.1% 0.0% 2.8% 0.0% 1.5%Multi-system Failure 0.0% 4.5% 0.0% 0.0% 1.8% 0.0% 0.9%Anticoagulant complication 0.0% 0.0% 0.0% 1.1% 0.9% 0.0% 0.6%Red Blood Cells transfused 52.4% 36.4% 34.0% 29.9% 54.1% 63.4% 44.6%Non-RBC blood products 33.3% 31.8% 21.3% 24.1% 27.5% 29.3% 26.6%Post-operative indicators Intubation Time <=10hrs 65.0% 76.2% 61.7% 76.7% 52.3% 48.8% 62.1% 10-20hrs 25.0% 9.5% 34.0% 18.6% 34.6% 36.6% 28.3% >20hrs 10.0% 14.3% 4.3% 4.7% 13.1% 14.6% 9.6%Post-op Length <= 5 days 19.0% 22.7% 23.4% 24.1% 14.7% 2.4% 17.7%of Stay 5-10 days 33.3% 54.5% 55.3% 58.6% 63.3% 75.6% 59.9% >10 days 47.6% 22.7% 21.3% 17.2% 22.0% 22.0% 22.3%Intensive Care <=24hrs 52.4% 45.5% 63.8% 64.4% 55.1% 36.6% 55.7%Stay >24hrs – 38.1% 40.9% 34.0% 32.2% 36.4% 53.7% 37.5% 4 days > 4 days 9.5% 13.6% 2.1% 3.4% 8.4% 9.8% 6.8%ASCTS Surgeon’s Comprehensive report 2001-2002 Page 43 of 8312/6/2010
    • Valve dataMorbidityBY AGESingle valve – Valve with CABG onlyPost-operative complications Age Group <40 40-49 50-59 60-69 70-79 80+ yrs years yrs yrs yrs yrs Totaln 0 2 15 63 116 35 231New Renal Failure - 0.0% 6.7% 12.7% 6.9% 25.7% 11.3%Cerebrovascular complication - 0.0% 0.0% 3.2% 4.3% 8.6% 4.3% Permanent Stroke - 0.0% 0.0% 3.2% 1.7% 2.9% 2.2% Transient Stroke - 0.0% 0.0% 0.0% 1.7% 5.7% 1.7% Continuous Coma - 0.0% 0.0% 0.0% 0.9% 0.0% 0.4%Deep Sternal Infection - 0.0% 0.0% 1.6% 0.9% 0.0% 0.9%Septicaemia - 0.0% 6.7% 1.6% 1.7% 8.6% 3.0%Return to theatre (all cause) - 0.0% 0.0% 9.5% 5.2% 8.6% 6.5%Re-op for Bleeding - 0.0% 0.0% 9.5% 2.6% 5.7% 4.8%Peri-operative AMI - 0.0% 0.0% 1.6% 1.7% 2.9% 1.7%New Cardiac Arrhythmia - 50.0% 26.7% 42.9% 42.2% 54.3% 43.3%Pneumonia - 0.0% 6.7% 6.3% 8.6% 17.1% 9.1%GIT complication - 0.0% 0.0% 3.2% 3.4% 5.7% 3.5%Multi-system Failure - 0.0% 6.7% 0.0% 2.6% 8.6% 3.0%Anticoagulant complication - 0.0% 0.0% 3.2% 0.9% 5.7% 2.2%Red Blood Cells transfused - 50.0% 40.0% 61.9% 68.1% 80.0% 66.2%Non-RBC blood products - 50.0% 13.3% 44.4% 44.8% 51.4% 43.7%Post-operative indicators Intubation Time <=10hrs - 50.0% 46.7% 47.6% 44.0% 42.9% 45.0% 10-20hrs - 50.0% 26.7% 31.7% 36.2% 25.7% 32.9% >20hrs - 0.0% 26.7% 20.6% 19.8% 31.4% 22.1%Post-op Length <= 5 days - 0.0% 26.7% 14.3% 5.2% 5.7% 9.1%of Stay 5-10 days - 50.0% 40.0% 47.6% 55.2% 51.4% 51.5% >10 days - 50.0% 33.3% 38.1% 39.7% 42.9% 39.4%Intensive Care <=24hrs - 0.0% 60.0% 38.1% 37.1% 11.4% 34.6%Stay >24hrs – - 100.0% 20.0% 47.6% 47.4% 65.7% 48.9% 4 days > 4 days - 0.0% 20.0% 14.3% 15.5% 22.9% 16.5%ASCTS Surgeon’s Comprehensive report 2001-2002 Page 44 of 8312/6/2010
    • Valve data Morbidity BY AGE Multiple valve – Valves onlyPost-operative complications Age Group <40 40-49 50-59 60-69 70-79 80+ yrs years yrs yrs yrs yrs Totaln 11 4 9 11 4 0 39New Renal Failure 9.1% 0.0% 0.0% 0.0% 0.0% - 2.6%Cerebrovascular complication 0.0% 0.0% 0.0% 9.1% 0.0% - 2.6% Permanent Stroke 0.0% 0.0% 0.0% 0.0% 0.0% - 0.0% Transient Stroke 0.0% 0.0% 0.0% 0.0% 0.0% - 0.0% Continuous Coma 0.0% 0.0% 0.0% 9.1% 0.0% - 2.6%Deep Sternal Infection 0.0% 0.0% 0.0% 0.0% 0.0% - 0.0%Septicaemia 18.2% 0.0% 0.0% 0.0% 0.0% - 5.1%Return to theatre (all cause) 9.1% 0.0% 11.1% 0.0% 0.0% - 5.1%Re-op for Bleeding 0.0% 0.0% 11.1% 0.0% 0.0% - 2.6%Peri-operative AMI 0.0% 0.0% 0.0% 0.0% 0.0% - 0.0%New Cardiac Arrhythmia 27.3% 50.0% 11.1% 27.3% 75.0% - 30.8%Pneumonia 9.1% 0.0% 0.0% 9.1% 0.0% - 5.1%GIT complication 9.1% 0.0% 11.1% 0.0% 0.0% - 5.1%Multi-system Failure 18.2% 0.0% 0.0% 9.1% 0.0% - 7.7%Anticoagulant complication 0.0% 0.0% 0.0% 0.0% 0.0% - 0.0%Red Blood Cells transfused 36.4% 25.0% 22.2% 36.4% 50.0% - 33.3%Non-RBC blood products 54.5% 25.0% 44.4% 45.5% 25.0% - 43.6%Post-operative indicators Intubation Time <=10hrs 72.7% 75.0% 44.4% 54.5% 0.0% - 53.8% 10-20hrs 9.1% 25.0% 55.6% 27.3% 100.0% - 35.9% >20hrs 18.2% 0.0% 0.0% 18.2% 0.0% - 10.3%Post-op Length <= 5 days 9.1% 25.0% 11.1% 18.2% 0.0% - 12.8%of Stay 5-10 days 72.7% 75.0% 66.7% 63.6% 50.0% - 66.7% >10 days 18.2% 0.0% 22.2% 18.2% 50.0% - 20.5%Intensive Care <=24hrs 27.3% 25.0% 22.2% 54.5% 0.0% - 30.8%Stay >24hrs – 63.6% 75.0% 66.7% 27.3% 75.0% - 56.4% 4 days > 4 days 9.1% 0.0% 11.1% 18.2% 25.0% - 12.8%ASCTS Surgeon’s Comprehensive report 2001-2002 Page 45 of 8312/6/2010
    • Isolated CABG dataNumber of Procedures Total Number of procedures Redo Surgery Mortality Mortality Number Number (30 days post op) (30 days post op) % of % of % of Procedure Number of Number of % of Isolated Number Procedure Number Procedure type procedures procedures Redo CABG type type (redo) Isolated CABG On 1738 86.0% 43 2.5% 92 94.8% 4 4.3% Pump Isolated CABG Off 284 14.0% 2 0.7% 5 5.2% 0 0.0% Pump TOTAL 2022 100.0% 45 2.2% 97 100.0% 4 4.1%Number of distal anastomoses Mean Procedure Total number of X1 X2 X3 X4 X5 X6 X7 no. type procedures grafts Isolated CABG On 1738 34 283 734 534 132 17 4 3.3 Pump Isolated CABG Off 284 62 115 69 25 8 3 2 2.4 Pump TOTAL 2022 96 389 803 559 140 20 6 3.2Arterial grafts All arterial T or Y grafts Procedure Total number of Number of % of procedure Number of % of procedure type procedures procedures type procedures type Isolated CABG On 1738 997 57.4% 183 10.5% Pump Isolated CABG Off 284 275 96.8% 124 43.7% Pump TOTAL 2022 1272 62.9% 307 15.2%Conduits used Total Number of IMA conduits Number of RAD Number of Number of Procedure number of (mutually exclusive) (mutually exclusive) GEPA SVG type procedures LIMA RIMA BIMA RAD x 1 RAD x 2 procedures procedures Isolated CABG On 1738 1340 23 277 903 435 1 741 Pump Isolated CABG Off 284 249 5 25 163 7 0 9 Pump TOTAL 2022 1589 28 302 1066 442 1 750 ASCTS Surgeon’s Comprehensive report 2001-2002 Page 46 of 83 12/6/2010
    • Isolated CABG data Patient characteristics BY CARDIAC SURGERY UNIT Age by Cardiac Surgery Unit 100 <40 years 40-49 years 50-59 years 80 60-69 years 70-79 years 80+ years 60 % 40 20No. cases 0A 405 A B C D E F TotalB 347C 307D 195E 250 Operative Status by Cardiac Surgery UnitF 518 100 ElectiveTotal 2022 Urgent Emergency 80 Salvage 60 % 40 20 0 A B C D E F Total Cardiac Surgery Unit ASCTS Surgeon’s Comprehensive report 2001-2002 Page 47 of 83 12/6/2010
    • Isolated CABG dataPatient characteristicsBY CARDIAC SURGERY UNIT History of Myocardial Infarction by Cardiac Surgery Unit 100 Previous MI 80 No previous MI 60 % 40 20No. casesA 405 0B 347 A B C D E F TotalC 307D 195E 250F 518 Time since last Myocardial Infarction by Cardiac Surgery UnitTotal 2022 100 >=21 days 80 8-20 days 1-7 days >6 + < 24 hours 60 <=6 hours % 40 20 0 A B C D E F Total Cardiac Surgery Unit ASCTS Surgeon’s Comprehensive report 2001-2002 Page 48 of 83 12/6/2010
    • Isolated CABG data Patient characteristics BY CARDIAC SURGERY UNIT LV Function by Cardiac Surgery Unit 100 Normal Mild 80 Moderate Severe 60 % 40 20 0 A B C D E F Total Cardiac Surgery UnitNo. casesA 405B 347C 307D 195E 250F 518Total 2022 ASCTS Surgeon’s Comprehensive report 2001-2002 Page 49 of 83 12/6/2010
    • Isolated CABG dataMortalityBY AGE 30 day Mortality (mortality/n %) Age Group <40 years 40-49 yrs 50-59 yrs 60-69 yrs 70-79 yrs 80+ yrs 0/14 0.0% 1/143 0.7% 5/454 1.1% 11/636 1.7% 22/675 3.3% 6/100 6.0%BY OPERATIVE STATUS 30 day Mortality (mortality/n %) Operative Status Elective Urgent Emergency Salvage 16/1267 1.3% 19/675 2.8% 9/73 12.3% 1/7 14.3%BY PRE-OPERATIVE AMI 30 day Mortality (mortality/n %) Pre-op AMI Time since AMI Yes No <6hrs 6-24hrs 1-7days 7-21days >21days34/1051 3.2% 11/970 1.1% 3/17 17.6% 1/12 8.3% 9/149 6.0% 7/166 4.2% 14/706 2.0%BY LV FUNCTION 30 day Mortality (mortality/n %) LV Dysfunction Normal Mild Moderate Severe 7/747 0.9% 7/652 1.1% 12/362 3.3% 19/246 7.7%MISCELLANEOUS 30 day Mortality (mortality/n %) Gender Redo Off-pump st Male Female 1 proc Redo Off-pump On-pump33/1514 2.2% 12/508 2.4% 41/1925 2.1% 4/97 4.1% 2/284 0.7% 43/1738 2.5% 30 day Mortality (mortality/n %) Smoking Status Diabetes Pre-op creatinine Current Non or Ex Yes No <=0.2mmol/L >0.2mmol/L 9/281 3.2% 36/1741 2.1% 13/652 2.0% 32/1370 2.3% 39/1968 2.0% 6/52 11.5% ASCTS Surgeon’s Comprehensive report 2001-2002 Page 50 of 83 12/6/2010
    • Isolated CABG data Morbidity BY AGEPost-operative complications Age Group <40 40-49 yrs 50-59 yrs 60-69 yrs 70-79 yrs 80+ yrs Total yearsn 14 143 454 636 675 100 2022New Renal Failure 0.0% 0.7% 2.0% 3.8% 4.3% 8.0% 3.5%Cerebrovascular complication 0.0% 0.0% 0.0% 0.9% 1.8% 5.0% 1.1% Permanent Stroke 0.0% 0.0% 0.0% 0.6% 1.2% 1.0% 0.6% Transient Stroke 0.0% 0.0% 0.0% 0.3% 0.6% 3.0% 0.4% Continuous Coma 0.0% 0.0% 0.0% 0.2% 0.3% 2.0% 0.2%Deep Sternal Infection 0.0% 0.0% 0.4% 1.3% 0.9% 1.0% 0.8%Septicaemia 0.0% 0.0% 0.7% 2.0% 1.0% 3.0% 1.3%Return to theatre (all cause) 0.0% 3.5% 2.4% 5.5% 4.6% 6.0% 4.4%Re-op for Bleeding 0.0% 2.1% 0.9% 3.1% 2.1% 2.0% 2.1%Peri-operative AMI 0.0% 0.7% 0.7% 0.9% 0.6% 4.0% 0.9%New Cardiac Arrhythmia 7.1% 13.3% 18.7% 28.7% 38.7% 49.0% 29.5%Pneumonia 0.0% 4.2% 4.2% 3.6% 5.2% 6.0% 4.4%GIT complication 0.0% 0.0% 1.3% 1.1% 3.1% 7.0% 2.0%Multi-system Failure 0.0% 0.0% 0.4% 0.8% 0.6% 2.0% 0.6%Anticoagulant complication 0.0% 1.4% 0.0% 0.5% 0.9% 0.0% 0.5%Red Blood Cells transfused 14.3% 19.6% 22.2% 36.9% 46.5% 64.0% 36.8%Non-RBC blood products 0.0% 16.1% 10.4% 21.4% 21.0% 24.0% 18.4%Post-operative indicators Intubation Time <=10hrs 69.2% 79.1% 73.5% 66.7% 61.3% 56.1% 66.8% 10-20hrs 23.1% 16.5% 20.4% 25.4% 27.6% 29.6% 24.6% >20hrs 7.7% 4.3% 6.2% 7.9% 11.1% 14.3% 8.7%Post-op Length <= 5 days 78.6% 49.0% 48.5% 31.6% 20.7% 15.0% 32.5%of Stay 5-10 days 21.4% 48.3% 46.3% 57.7% 63.9% 56.0% 56.2% >10 days 0.0% 2.8% 5.3% 10.7% 15.4% 29.0% 11.3%Intensive Care <=24hrs 85.7% 69.2% 67.6% 60.7% 57.5% 45.9% 61.3%Stay >24hrs – 14.3% 28.7% 29.3% 34.2% 36.8% 40.8% 33.8% 4 days > 4 days 0.0% 2.1% 3.1% 5.1% 5.6% 13.3% 5.0% ASCTS Surgeon’s Comprehensive report 2001-2002 Page 51 of 83 12/6/2010
    • Isolated CABG dataMorbidityBY OPERATIVE STATUSPost-operative complications Operative Status Elective Urgent Emergency Salvage Totaln 1267 675 73 7 2022New Renal Failure 3.4% 3.3% 6.8% 14.3% 3.5%Cerebrovascular complication 1.0% 1.0% 4.1% 0.0% 1.1% Permanent Stroke 0.6% 0.4% 2.7% 0.0% 0.6% Transient Stroke 0.4% 0.4% 1.4% 0.0% 0.4% Continuous Coma 0.2% 0.1% 1.4% 0.0% 0.2%Deep Sternal Infection 0.6% 1.2% 1.4% 0.0% 0.8%Septicaemia 1.1% 1.2% 4.1% 14.3% 1.3%Return to theatre (all cause) 3.8% 4.6% 12.3% 0.0% 4.4%Re-op for Bleeding 2.1% 1.9% 5.4% 0.0% 2.1%Peri-operative AMI 0.8% 0.9% 1.4% 14.3% 0.9%New Cardiac Arrhythmia 29.5% 28.7% 37.0% 42.9% 29.5%Pneumonia 3.5% 5.0% 11.0% 42.9% 4.4%GIT complication 1.8% 2.4% 2.7% 0.0% 2.0%Multi-system Failure 0.4% 0.7% 4.1% 0.0% 0.6%Anticoagulant complication 0.4% 0.3% 5.5% 0.0% 0.5%Red Blood Cells transfused 33.9% 38.8% 63.0% 85.7% 36.8%Non-RBC blood products 17.5% 16.4% 46.6% 71.4% 18.4%Post-operative indicators Intubation Time <=10hrs 69.5% 65.0% 43.1% 0.0% 66.8% 10-20hrs 23.6% 26.4% 25.0% 28.6% 24.6% >20hrs 6.9% 8.6% 31.9% 71.4% 8.7%Post-op Length <= 5 days 34.6% 29.6% 23.3% 28.6% 32.5%of Stay 5-10 days 56.6% 56.1% 50.7% 42.9% 56.2% >10 days 8.8% 14.2% 26.0% 28.6% 11.3%Intensive Care <=24hrs 61.9% 62.9% 38.9% 14.3% 61.3%Stay >24hrs – 34.8% 31.4% 34.7% 71.4% 33.8% 4 days > 4 days 3.3% 5.7% 26.4% 14.3% 5.0% ASCTS Surgeon’s Comprehensive report 2001-2002 Page 52 of 83 12/6/2010
    • Isolated CABG data Morbidity BY OPERATIVE STATUS AND CARDIAC SURGERY UNIT New Renal Failure by Operative Status and Cardiac Surgery Unit 16 Elective (2) Urgent 14 Emergency or Salvage (2) (1) 12 (n) number of cases 10 (5) (1) % 8 (6) 6 (21) (4) 4 (6) (4) (43) (22) (4) (5) (3) (5) (3) (3) 2 (2) (0) (0) 0 A B C D E F Total Permanent Stroke by Operative Status and Cardiac Surgery Unit 14 Elective No. cases (1) Urgent Emergency or Salvage 12 A 405 (n) number of cases 10 B 347 C 307 8 D 195 % E 250 6 F 518 (1) 4 (2) Total 2022 2 (3) (2) (1) (1) (1) (1) (2) (8)(3) (0) (0) (0)(0) (0)(0)(0) (0)(0) 0 A B C D E F Total Re-op for Bleeding by Operative Status and Cardiac Surgery Unit 20 Elective (2) Urgent 18 Emergency or Salvage 16 (n) number of cases 14 12 % 10 8 (1) 6 (4) (9) (6) (1) (6) 4 (3) (3) (2) (26) (13) 2 (2) (2) (2) (4) (0) (0) (0)(0) (0) 0 A B C D E F Total Cardiac Surgery UnitASCTS Surgeon’s Comprehensive report 2001-2002 Page 53 of 8312/6/2010
    • Isolated CABG dataMorbidityBY PRE-OPERATIVE AMIPost-operative complications Pre-op AMI Time since AMI Total 7-21day >21 Yes No <6hrs 6-24hrs 1-7days s daysn 1051 970 17 12 149 166 706 2022New Renal Failure 4.1% 2.9% 5.9% 0.0% 6.7% 3.0% 3.8% 3.5%Cerebrovascular complication 1.1% 1.1% 0.0% 0.0% 1.3% 0.0% 1.4% 1.1% Permanent Stroke 0.7% 0.6% 0.0% 0.0% 0.7% 0.0% 0.9% 0.6% Transient Stroke 0.5% 0.4% 0.0% 0.0% 0.7% 0.0% 0.6% 0.4% Continuous Coma 0.3% 0.2% 0.0% 0.0% 0.7% 0.0% 0.3% 0.2%Deep Sternal Infection 1.0% 0.6% 0.0% 0.0% 1.3% 0.6% 1.1% 0.8%Septicaemia 1.3% 1.2% 0.0% 0.0% 1.3% 1.8% 1.3% 1.3%Return to theatre (all cause) 4.9% 3.7% 5.9% 8.3% 9.4% 0.6% 4.8% 4.3%Re-op for Bleeding 2.1% 2.1% 5.9% 0.0% 2.7% 0.0% 2.4% 2.1%Peri-operative AMI 1.3% 0.4% 5.9% 8.3% 1.3% 1.8% 1.0% 0.9%New Cardiac Arrhythmia 28.1% 31.1% 47.1% 33.3% 24.2% 24.1% 29.2% 29.6%Pneumonia 4.8% 4.0% 11.8% 16.7% 6.7% 5.4% 3.8% 4.4%GIT complication 1.5% 2.6% 0.0% 0.0% 2.7% 1.2% 1.4% 2.0%Multi-system Failure 0.9% 0.4% 0.0% 8.3% 2.0% 0.6% 0.6% 0.6%Anticoagulant complication 0.3% 0.8% 11.8% 0.0% 0.0% 0.6% 0.0% 0.5%Red Blood Cells transfused 38.7% 34.6% 64.7% 58.3% 43.0% 36.1% 37.3% 36.7%Non-RBC blood products 19.0% 17.6% 58.8% 41.7% 22.1% 13.3% 18.4% 19.1%Post-operative indicators Intubation Time <=10hrs 64.8% 68.9% 29.4% 33.3% 57.2% 71.8% 66.3% 66.8% 10-20hrs 24.8% 24.4% 29.4% 33.3% 25.5% 20.9% 25.3% 24.6% >20hrs 10.3% 6.7% 41.2% 33.3% 17.2% 7.4% 8.4% 8.6%Post-op Length <= 5 days 31.4% 33.7% 29.4% 16.7% 30.9% 37.3% 30.5% 32.5%of Stay 5-10 days 56.1% 56.3% 52.9% 58.3% 47.7% 51.8% 58.9% 56.2% >10 days 12.5% 10.0% 17.6% 25.0% 21.5% 10.8% 10.6% 11.3%Intensive Care <=24hrs 58.1% 64.8% 41.2% 41.7% 56.2% 59.4% 58.8% 61.3%Stay >24hrs – 36.0% 31.4% 35.3% 41.7% 30.8% 35.8% 37.1% 33.8% 4 days > 4 days 6.0% 3.8% 23.5% 16.7% 13.0% 4.8% 4.1% 4.9% ASCTS Surgeon’s Comprehensive report 2001-2002 Page 54 of 83 12/6/2010
    • Isolated CABG data Morbidity MISCELLANEOUSPost-operative complications Gender Redo Off-pump Pre-op creatinine Total Off- On- <=0.2m >0.2m Male Female 1st proc Redo pump pump mol/L mol/Ln 1514 508 1925 97 284 1738 1968 52 2022New Renal Failure 3.2% 4.3% 3.4% 5.2% 3.2% 3.6% 3.1% 17.3% 3.5%Cerebrovascular 1.2% 1.0% 1.1% 1.0% 0.7% 1.2% 1.1% 3.8% 1.1%complication Permanent Stroke 0.6% 0.8% 0.7% 0.0% 0.4% 0.7% 0.6% 3.8% 0.6% Transient Stroke 0.6% 0.0% 0.5% 0.0% 0.4% 0.5% 0.5% 0.0% 0.4% Continuous Coma 0.1% 0.6% 0.2% 1.0% 0.0% 0.3% 0.3% 0.0% 0.2%Deep Sternal Infection 0.8% 1.0% 0.8% 2.1% 0.4% 0.9% 0.8% 3.8% 0.8%Septicaemia 1.2% 1.6% 1.2% 3.1% 0.7% 1.4% 1.1% 9.6% 1.3%Return to theatre (all cause) 4.3% 4.5% 4.2% 7.3% 2.8% 4.6% 4.2% 9.6% 4.4%Re-op for Bleeding 2.4% 1.4% 2.1% 2.1% 1.4% 2.2% 2.1% 1.9% 2.1%Peri-operative AMI 0.9% 1.0% 0.9% 0.0% 0.7% 0.9% 0.9% 0.0% 0.9%New Cardiac Arrhythmia 28.9% 31.5% 29.6% 29.2% 22.2% 30.7% 29.4% 34.6% 29.5%Pneumonia 4.1% 5.3% 4.4% 5.2% 2.8% 4.7% 4.3% 9.6% 4.4%GIT complication 2.0% 2.0% 2.0% 2.1% 1.8% 2.1% 2.0% 3.8% 2.0%Multi-system Failure 0.5% 1.2% 0.6% 1.0% 0.0% 0.7% 0.6% 1.9% 0.6%Anticoagulant complication 0.7% 0.2% 0.6% 0.0% 0.0% 0.6% 0.6% 0.0% 0.5%Red Blood Cells transfused 32.5% 49.4% 36.6% 40.6% 16.2% 40.1% 36.1% 59.6% 36.8%Non-RBC blood products 19.4% 15.4% 18.2% 22.9% 4.6% 20.7% 18.1% 25.0% 18.4%Post-operative indicators Intubation Time <=10hrs 68.5% 61.6% 67.3% 55.8% 81.6% 64.5% 67.2% 51.0% 66.8% 10-20hrs 23.1% 28.9% 24.4% 28.4% 15.3% 26.0% 24.2% 37.3% 24.6% >20hrs 8.4% 9.4% 8.3% 15.8% 3.1% 9.5% 8.5% 11.8% 8.7%Post-op Length <= 5 days 34.7% 25.8% 33.1% 20.6% 51.8% 29.3% 32.9% 17.3% 32.5%of Stay 5-10 days 55.2% 59.1% 55.8% 63.9% 40.8% 58.7% 56.6% 42.3% 56.2% >10 days 10.0% 15.2% 11.1% 15.5% 7.4% 12.0% 10.5% 40.4% 11.3%Intensive Care <=24hrs 62.3% 58.1% 61.4% 58.3% 61.2% 61.3% 61.7% 45.1% 61.3%Stay >24hrs – 33.2% 35.4% 33.9% 31.3% 36.6% 33.3% 33.9% 31.4% 33.8% 4 days > 4 days 4.5% 6.5% 4.7% 10.4% 2.2% 5.4% 4.5% 23.5% 5.0% ASCTS Surgeon’s Comprehensive report 2001-2002 Page 55 of 83 12/6/2010
    • Other Group data Total number of procedures Mortality (30 days post op) by procedureSurgery type (NOT mutually Number of % of total Number of % of Surgeryexclusive) procedures procedures patients typeLeft Ventricular Aneurysm 31 1.2% 2 6.5%Acquired VSD 8 1.2% 2 25.0%Aortic 98 3.3% 13 13.3% Aneurysm – Asc only 41 1.4% 0 0.0% – Asc + arch 9 0.3% 0 0.0% – Arch only 0 0.0% – Desc 3 0.1% 0 0.0% – Thor/abd only 5 0.2% 3 60.0% – Other 2 0.1% 0 0.0% Disection – Asc – Acute 28 0.9% 9 32.1% – Asc – Chronic 2 0.1% 0 0.0% – Desc – Acute 2 0.1% 0 0.0% – Desc – Chronic 1 <0.1% 0 0.0% Acute Traumatic Aortic 8 0.3% 1 12.5% TransectionCongenital - ASD 28 0.9% 1 2.9% - Other 14 0.5% 0 0.0%Cardiac Trauma 8 0.3% 3 37.5%Pericardiectomy 6 0.2% 0 0.0%Cardiac Tumour 11 0.4% 0 0.0% ASCTS Surgeon’s Comprehensive report 2001-2002 Page 56 of 83 12/6/2010
    • Factors contributing to Morbidity in the Whole Population BY AGE Age Group <40 40-49 yrs 50-59 yrs 60-69 yrs 70-79 yrs 80+ yrs Total yearsn 106 214 586 894 981 193 2974New Renal Failure 5.7% 3.8% 3.4% 4.9% 6.8% 13.5% 5.8%Cerebrovascular complication 1.9% 2.3% 0.5% 2.5% 2.7% 5.2% 2.3% Permanent Stroke 1.0% 1.4% 0.3% 1.6% 1.5% 2.1% 1.3% Transient Stroke 0.0% 0.0% 0.0% 0.8% 0.7% 2.6% 0.6% Continuous Coma 1.0% 1.9% 0.2% 0.3% 0.6% 1.0% 0.6%Deep Sternal Infection 0.0% 0.5% 0.5% 1.0% 0.8% 0.5% 0.7%Re-op for Bleeding 7.5% 3.3% 1.5% 4.0% 2.9% 3.1% 3.2%Intubation Time <=10hrs 50.5% 72.1% 68.7% 62.4% 56.2% 50.5% 61.1% 10-20hrs 19.2% 15.9% 22.3% 25.8% 29.8% 30.0% 25.8% >20hrs 30.3% 12.0% 9.0% 11.8% 14.0% 19.5% 13.2%Post-op Length <= 5 days 31.1% 41.6% 42.0% 27.0% 18.1% 11.9% 27.2%of Stay 5-10 days 29.2% 47.2% 46.4% 55.7% 61.0% 56.0% 54.1% >10 days 39.6% 11.2% 11.6% 17.3% 20.9% 32.1% 18.7%Intensive Care <=24hrs 40.8% 58.2% 63.0% 55.3% 52.9% 36.6% 54.5%Stay >24hrs – 37.9% 33.3% 31.2% 36.3% 38.8% 47.6% 36.7% 4 days > 4 days 21.4% 8.5% 5.9% 8.5% 8.3% 15.7% 8.8% ASCTS Surgeon’s Comprehensive report 2001-2002 Page 57 of 83 12/6/2010
    • Factors contributing to Morbidity in the Whole PopulationBY PROCEDURE TYPE Procedure Type Isolated Valve(s) + Valve(s) only Other Total CABG CABGn 2022 366 238 348 2974New Renal Failure 3.5% 4.1% 10.9% 17.1% 5.8%Deep Sternal Infection 0.8% 0.0% 0.8% 0.9% 0.7%Re-op for Bleeding 2.1% 5.7% 4.6% 5.5% 3.2%Red Blood Cells transfused 36.8% 43.4% 66.4% 59.2% 42.6%Non-RBC blood products 18.4% 28.4% 44.1% 49.4% 25.3%transfusedIntubation Time <=10hrs 66.8% 61.2% 44.7% 39.0% 61.1% 10-20hrs 24.6% 29.1% 32.5% 24.3% 25.8% >20hrs 8.7% 9.7% 22.8% 36.6% 13.2%Post-op Length <= 5 days 32.5% 17.2% 9.2% 19.5% 27.2%of Stay 5-10 days 56.2% 60.7% 51.7% 36.5% 54.1% >10 days 11.3% 22.1% 39.1% 44.0% 18.7%Intensive Care <=24hrs 61.3% 53.0% 34.2% 30.2% 54.5%Stay >24hrs – 33.8% 39.6% 48.9% 42.3% 36.7% 4 days > 4 days 5.0% 7.4% 16.9% 27.5% 8.8% ASCTS Surgeon’s Comprehensive report 2001-2002 Page 58 of 83 12/6/2010
    • Factors contributing to Morbidity in the Whole Population BY LV FUNCTION LV Dysfunction Normal Mild Moderate Severe Totaln 1177 875 490 380 2922New Renal Failure 4.0% 4.1% 8.6% 9.7% 5.5%Cerebrovascular complication 2.3% 1.9% 2.2% 2.6% 2.2% Permanent Stroke 1.3% 1.1% 1.6% 1.3% 1.3% Transient Stroke 0.8% 0.8% 0.2% 0.3% 0.6% Continuous Coma 0.4% 0.2% 0.6% 1.3% 0.5%Intubation Time <=10hrs 63.5% 65.4% 56.5% 52.0% 61.4% 10-20hrs 27.1% 25.1% 29.3% 19.3% 25.9% >20hrs 9.4% 9.5% 14.1% 28.6% 12.7%Post-op Length <= 5 days 29.4% 28.8% 20.0% 26.9% 27.3%of Stay 5-10 days 54.6% 55.3% 59.9% 44.9% 54.4% >10 days 16.0% 15.9% 20.2% 28.2% 18.3% ASCTS Surgeon’s Comprehensive report 2001-2002 Page 59 of 83 12/6/2010
    • Factors contributing to Morbidity in the Whole PopulationBY DIABETES Diabetes Yes No Totaln 827 2144 2971Cerebrovascular complication 1.7% 2.5% 2.3% Permanent Stroke 1.5% 1.3% 1.3% Transient Stroke 0.1% 0.8% 0.6% Continuous Coma 0.2% 0.7% 0.6%Deep Sternal Infection 1.6% 0.4% 1.7%BY STATUS Operative Status Elective Urgent Emergency Salvage Totaln 1908 886 155 25 2974Cerebrovascular complication 1.7% 2.0% 10.3% 8.0% 2.3% Stroke permanent 1.1% 1.0% 5.2% 4.5% 1.3% Transient Stroke 0.6% 0.7% 1.3% 0.0% 0.6% Continuous Coma 0.2% 0.3% 5.8% 9.1% 0.6%Re-op for Bleeding 3.0% 2.5% 7.1% 16.0% 3.2%Post-op Length <= 5 days 28.4% 25.8% 18.7% 40.0% 27.2%of Stay 5-10 days 58.0% 50.5% 32.9% 16.0% 54.1% >10 days 13.6% 23.7% 48.4% 44.0% 18.7% ASCTS Surgeon’s Comprehensive report 2001-2002 Page 60 of 83 12/6/2010
    • Factors contributing to Morbidity in the Whole Population BY REDO Redo 1st Proc Redo Totaln 2743 231 2974Re-op for Bleeding 3.1 3.5 3.2Intubation Time <=10hrs 62.3% 46.0% 61.1% 10-20hrs 25.8% 25.9% 25.8% >20hrs 11.9% 28.1% 13.2%Post-op Length <= 5 days 28.3% 15.2% 27.2%of Stay 5-10 days 54.4% 50.6% 54.1% >10 days 17.4% 34.2% 18.7% BY RESPIRATORY DISEASE Respiratory Disease No Mild Moderate Severe Totaln 2458 408 75 27 2968Deep Sternal Infection 0.6% 1.5% 1.3% 0.0% .7%Intubation Time <=10hrs 61.8% 60.2% 49.3% 38.5% 61.1% 10-20hrs 25.8% 24.1% 33.3% 23.1% 25.8% >20hrs 12.3% 15.7% 17.3% 38.5% 13.2% ASCTS Surgeon’s Comprehensive report 2001-2002 Page 61 of 83 12/6/2010
    • Factors contributing to Morbidity in the Whole PopulationMISCELLANEOUS Previous Cerebrovascular Disease Atrial Arrythmia Yes No Total Yes No Totaln 319 2651 2970 319 2655 2974Cerebrovascular complication 5.3% 1.9% 2.3% 4.7% 2.0% 2.3% Permanent Stroke 2.5% 1.2% 1.3% 2.2% 1.2% 1.3% Transient Stroke 1.3% 0.6% 0.6% 0.6% 0.6% 0.6% Continuous Coma 2.5% 0.3% 0.5% 2.2% 0.4% 0.6% CPB time 0 hrs >0 - 1hr >1 – 3 hrs >3 hrs Totaln 308 139 2272 274 2973Cerebrovascular complication 0.6% 0.0% 1.7% 9.5% 2.3% Permanent Stroke 0.3% 0.0% 1.1% 5.2% 1.3% Transient Stroke 0.3% 0.0% 0.5% 2.6% 0.6% Continuous Coma 0.0% 0.0% 0.4% 3.0% 0.6% Return to theatre BITA Obesity (all cause) Yes No Total Yes No Total Yes No Totaln 318 2652 2970 186 2784 2970 848 2122 2970Deep Sternal Infection 2.5% 0.5% 0.7% 7.0% 0.3% 0.7% 1.1% 0.6% 0.7% Pre-op anti-platelet Yes No Totaln 1226 1746 1972Re-op for bleeding 3.3 3.1 3.2 ASCTS Surgeon’s Comprehensive report 2001-2002 Page 62 of 83 12/6/2010
    • In-house reporting module – report from all units combinedThe ASCTS Database software contains an In-House reporting module, whichprovides a report on case numbers and outcomes for the individual unit as required.The following pages display a copy of that report generated by the same software, butfor all units data combined.The report is provided here to allow individual units to compare the report generatedat their own site to that from the whole state.PLEASE NOTE: minor discrepancies between the report from the In-House reportingmodule and the Comprehensive Surgeon’s Report are the result of differences infiltering processes prior to analysis whereby cases are excluded. ASCTS Surgeon’s Comprehensive report 2001-2002 Page 63 of 83 12/6/2010
    • ASCTS Surgeon’s Comprehensive report 2001-2002 Page 72 of 8312/6/2010
    • ProcessesThe following pages outline formal processes relating to the conduct of the project.These include:• Data management• Peer Review mechanism• Data collection form• Patient Information Sheet• Opt-off procedureASCTS Surgeon’s Comprehensive report 2001-2002 Page 73 of 8312/6/2010
    • Data ManagementAll data collected as part of the ASCTS project is forwarded to the Baker HeartResearch Institute. The flow of information into the data centre is outlined in thefollowing figure. Surgical Unit Interim Unit Surgical Unit Final Registry Merged Surgical Unit Unit State Registry Registr Surgical Unit y Error Correction Surgical UnitASCTS Surgeon’s Comprehensive report 2001-2002 Page 74 of 8312/6/2010
    • Current Peer Review Mechanism for identification of Unit outliers STEP 1: Identification of outlier on Control Chart Week 0 STEP 3: CDA reviews local audit report and discusses results with Unit Week 8 STEP 2: Unit contacted and asked to undertake internal review of the past 3 months data and report within 4 weeks Week 4 STEP 4: Review most recent KPI data: Result within limits - No action required KPI remains out of range Week 12 STEP 6: CDA reviews external audit report and discusses results with Unit Week 20 STEP 5: Unit contacted and asked to agree to external review of the past 3 months data and report within 4 weeks Week 16 STEP 7: Review most recent KPI data: Result within limits - No action required KPI remains out of range Week 24 STEP 8: Unit contacted and meeting arranged with hospital administration and Department of HealthASCTS Surgeon’s Comprehensive report 2001-2002 Page 75 of 8312/6/2010
    • Data Collection FormGENERAL DESCRIPTIONThe following pages show the ASCTS Data Collection Form. This form contains only theASCTS Minimum Dataset. Individual Hospitals may have a slightly different form dependingon the type and amount of additional data each Hospital wishes to collect.The ASCTS Data collection form consists of 3 parts: Pre operative, Intra Operative and PostOperative.Pre Operative:We recommend that this section of the form should be completed by the Resident.This part of the form contains information on the patient’s demographics, risk factors, preoperative cardiac status and previous interventions.Intra Operative:We recommend that this section of the form should be completed by the Surgeon.This part of the form contains information on the patient’s haemodynamic data, operativestatus, and information directly related to the procedure performed.Post Operative:We recommend that this section of the form should be completed by the Registrar.This part of the form contains information on post operative complications and mortality.We also recommend that the Data Manager check all parts of the form for completeness andmake any amendment as required.Each part is contained on separate pages from the other parts. They can therefore be separatedfrom each other for the purposes of data collection if required.IMPORTANT INSTRUCTIONS FOR FILLING IN THE FORMSThe form has been designed for the purposes of scanning. During the first phase of the projectthe form will be submitted to The Baker Institute for the purposes of data entry into theASCTS Database. As a scan form it is important that the form be completed in the followingmanner:• Complete the form with an ink pen (preferably black).• Enter any values such as numbers or letters within the boxes, with one character per box.• Enter letters and block letters (capitals).• Shade in the circles for yes/no questions and multiple-choice questions. Do NOT tick or cross them.SUBMISSION OF DATA TO THE ASCTS PROJECTWhen all 3 parts of the form have been completed and checked this should be indicated on thetop of the first page. The entire form should then be faxed to 1800 650 573.ASCTS Surgeon’s Comprehensive report 2001-2002 Page 76 of 8312/6/2010
    • Data Collection Form – Pre Operative page 1ASCTS Surgeon’s Comprehensive report 2001-2002 Page 77 of 8312/6/2010
    • Data Collection Form – Pre Operative page 2ASCTS Surgeon’s Comprehensive report 2001-2002 Page 78 of 8312/6/2010
    • Data Collection Form – Intra Operative page 1ASCTS Surgeon’s Comprehensive report 2001-2002 Page 79 of 8312/6/2010
    • Data Collection Form – Intra Operative page 2ASCTS Surgeon’s Comprehensive report 2001-2002 Page 80 of 8312/6/2010
    • Data Collection Form – Post OperativeASCTS Surgeon’s Comprehensive report 2001-2002 Page 81 of 8312/6/2010
    • Patient Information SheetADULT CARDIAC SURGERY DATABASEIntroductionYou are about to have a cardiac surgery operation. Generally heart surgery is successful in improving thequality and length of the patient’s life, with a small risk of death or major complications. However, incertain people the surgery is less successful. This may be due to some people having characteristics thatincrease their risk of complications, or it may be due to the type of operation done and the circumstancesin which it is performed.In order to improve the success of heart surgery we need to know what factors increase a patient’s risk ofcomplications, and which surgical procedures have the most successful outcome. To achieve this, the Victorianbranch of the Australian Society of Cardiac and Thoracic Surgeons (ASCTS) has set up a Cardiac SurgeryDatabase to monitor the results of cardiac operations.The database aims to record information on every adult having a cardiac surgery operation. The success of thedatabase depends on the amount of data we collect. We are asking you to participate in the Cardiac SurgeryDatabase, by allowing us to document information relevant to your operation.What Information Do We Need?The information we require includes your name, date of birth, Medicare Number, hospital identification number,the name of the hospital the reason you are having cardiac surgery and other information directly related to yourproposed operation.All of your information will be freely available to you.We Will Keep Your Information ConfidentialYour personal information is confidential and cannot be used outside the database. Procedures are in place toprotect your information and keep it confidential. Registry data is accessible by authorised staff of the CardiacSurgery Database project. Aggregate data will be made available through the reporting system of ASCTS. Youcannot be identified in any reports produced by the registry.How We Will Collect The Information?You are not required to do anything. The hospital staff will complete the forms that contain your details duringyour hospital stay. The information will be entered onto the database computer.Risk And Benefits – To YouYour information is protected and we are not allowed to identify you by law. The database will produce generalreports on the success of surgery which we anticipate will improve the quality of cardiac surgery in the future.Having your data entered into the Database will not alter the care and treatment you receive for your currentsurgery in any way.You Can Choose Not To Be In The DatabaseWe understand that not everyone is comfortable about having details related to their cardiac conditiondocumented in a database. If you feel this way, and do not want this information added to the database, pleasecontact the Project Co-ordinator on 1800 998 722 within two weeks of the operation. (You can always have yourinformation removed from the database later simply by contacting the Project Co-ordinator)A decision on whether or not you wish to be involved in the registry does not affect your treatment in any way.If you have any questions, concerns or require further information about the Cardiac Surgery Database, please donot hesitate to contact the Project Co-ordinator on 1800 998 722.ASCTS Surgeon’s Comprehensive report 2001-2002 Page 82 of 8312/6/2010
    • Consent procedureIn order to “Opt-off” from the ACST Cardiac Surgery Project, the patient, or theirrepresentative must call the 1800 number provided to him/her on the Patient InformationSheet.An “Opt-off” cannot be done by staff at the hospital where the patient is undergoing thecardiac procedure.The following procedure will be followed by the Project Manager when patient’s ring the 1800number to request that they not be included in the ASCTS Cardiac Surgery Project. This isprovided here in case the patient wishes to have more information about the Opt-offprocedure prior to calling the 1800 number.Procedure For Processing Opt-Out Requests1. Obtain Name, date of birth, Hospital where surgery was performed, approximate date thatsurgery was performed and contact phone number. (in order to identify the record to bedeleted).2. Ask if the patient has any questions about the database or would like any furtherexplanation of how and why the data is collected.3. Ask the Patient “Would you like me to not add your information to the Register?”4. Ask the patient “You do not have to tell me, but may I ask you why you would not like yourinformation to be included in the database?”5. After receiving the answer to the above question DO NOT offer any more explanations ortry to change the patient’s mind – the patient’s decision is final.6. Thank the patient – notify them that if they undergo a new surgical procedure they will needto Opt-off again. We will not be retaining the patient’s details if the data is not added – Wewill however retain the information that a patient who underwent a surgical procedure at thathospital in the calendar month of the Date of Surgery withdrew their data from the database,and the reasons for withdrawal.7. Check the database for the appropriate record. If a near match is found but not sure thencontact the patient to confirm. If a match is not found then retain the information until therecord arrives (records will not be received until at least 1 month post surgery).ASCTS Surgeon’s Comprehensive report 2001-2002 Page 83 of 8312/6/2010